Tenosynovitis

TENOSYNOVITIS

What is tenosynovitis?

Tenosynivitis is inflammation of the sheath that surrounds a tendon as opposed to inflammation of the actual tendon itself (tendinitis or tendonitis). de Quervain’s tenosynivitis is inflammation of the synovium of the abductor pollicis longus and extensor pollicis longus muscles as they pass through the wrist (on the thumb side of the wrist). It occurs more frequently in racket sports such as tennis, squash or badminton as well as canoing and ten pin bowling. It also occurs in golfers (left thumb of a right handed golfer and vice versa).pinching,grasping and other movements of the thumb can be painful.

Symptoms of de Quervain’s tenosynovitis

  • Tenderness near the base of the thumb
  •  swelling on the thumb side of the wrist where the tendons pass.
  • Creptius may be felt (a creaking of the tendon as it moves).
  • Finkelstein’s test may be positive (thumb is placed in the palm of the hand and wrist moved laterally towards the little finger to stretch the tendons – pain may be felt).
  •  Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve
  • A fluid-filled cyst in the same region as the swelling and pain
  •  Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching
  • A “sticking” or “stop-and-go” sensation in your thumb when trying to move it
  • A squeaking sound as the tendons try to move back and forth through the inflamed sheaths

Causes

  • A common cause is chronic overuse of your wrist while doing combination mavements
  • Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
  • Inflammatory arthritis, such as rheumatoid arthritis

Risk factors

People most at risk of de Quervain’s tenosynovitis tend to be those whose occupations or hobbies involve repetitive hand and wrist motions, such as carpenters, office workers and musicians

Treatment

  • Rest, splinting if necessary.
  • Using an extra thick pen may help as this reduces the stretch on the tendons when writing.
  • Ice or cold therapy to reduce pain and inflammation.

Visit Physioline for treatment and rehabilitation.

  • Ultrasound
  • Stretching and strengthening.
  •  Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
  •  Avoiding repetitive thumb movements whenever possible
  •  Avoiding pinching with your thumb when moving your wrist from side to side
  • A cortisone injection may be given.
  • In rare cases surgery may be indicated.

Complcations

Left untreated, de Quervain’s tenosynovitis may permanently restrict movement of the tendons of your wrist, making it difficult for you to bend your wrist, pinch, grasp or make a fist. The tendon sheaths could rupture. Additionally, an underlying infection may spread into your hand or your arm, causing further pain and discomfort

Prevention

If possible, make a conscious effort to avoid repetitive wrist and hand movements and pinching with your thumb when moving your wrist from side to side